WORKING PAPER ON PROJECTED COSTS OF

MARIJUANA LEGALIZATION IN ILLINOIS

April 2018

400 N. Columbus Street, Suite 202 Alexandria, VA 22314

http://www.learnaboutsam.org

2

Table of Contents

I. Introduction/Summary ...................................................................................................... 3

II. Costs .................................................................................................................................... 5

A. Regulatory Costs .................................................................................................................. 5

B. Increased Drugged Driving Fatalities .................................................................................. 7

C. Increased Serious Injuries from Drugged Driving Crashes ................................................. 9

D. Increased Property Damage to Vehicles from Drugged Driving........................................10

E. Short-term health consequences ........................................................................................ 10

1. Increased ER visits for marijuana poisonings ............................................................... 10

2. Marijuana concentrate extraction lab explosions .......................................................... 10

F. Increased Homelessness .................................................................................................... 12

G. Workplace costs ................................................................................................................ 13

1. Absenteeism .................................................................................................................. 14

2. Marijuana-related workplace injuries (full-time employees) ........................................ 15

H. Additional, presently unquantifiable costs ........................................................................ 16

1. Long-term health effects ............................................................................................... 16

2. Other costs ..................................................................................................................... 19

III. Conclusion ....................................................................................................................... 22

3

I. Introduction/Summary

Potential revenue resulting from the legalization of marijuana is often discussed as a remedy for

lagging state budgets. Indeed, 24/7 Wall St. reports “marijuana sales could add to state coffers an

estimated $566 million in excise tax revenue per year,”1 which is in the middle of the low

($350M) and high ($700M) projections estimated by pro-marijuana groups like the Marijuana

Policy Project. This report finds that legalization in Illinois, however, would cost at least

$670 million, outweighing the projected tax revenue.

To justify legalization, proponents often cite high criminal justice costs, often not recognizing

that in 2016 Illinois decriminalized possession of small amounts of marijuana. Additionally, the

issue of legalization is often confused with the matter of medical marijuana, claiming the drug is

necessary to aid those in need of medication.

Supporters of the commercialization of marijuana often fail to acknowledge the costs resulting

from marijuana use, including, but not limited to, drugged driving crashes and increased

workplace absenteeism.

Catalyst members have partnered with SAM to create this study in an attempt to publish valuable

data in regard to the costs of the commercialization of marijuana. While we believe that this

study has viable financial information about the monetary costs related to Illinois, we also feel

that there are experiences far more significant than quantitative cost data. It is crucial to examine

this cost study as one element of a larger view on the issue of marijuana in Illinois – an issue that

touches individuals, families, and communities.

Much has been said about the revenues that marijuana legalization might bring to Illinois. Few,

however, discuss the costs of such a policy. Omitting costs is a critical oversight: no policy or

business plan would be complete without discussing both sides of the balance sheet. It is also

important to note that this study uses similar methods as previous studies by SAM estimating

costs in Rhode Island and Connecticut.

Although a full cost accounting of marijuana legalization would be impossible at present, enough

data exists to make rough-and-ready estimates of certain likely direct and short-term costs, such

as:

1. Administrative and enforcement costs for regulators

2. Increased drugged driving fatalities

3. Increased serious injuries from drugged driving crashes

4. Increased Property Damage to Vehicles from Drugged Driving

5. Short-term health costs

a. More emergency room visits for marijuana poisonings

1 Found here: http://www.kwqc.com/content/news/Report--Illinois-likely-to-legalize-recreational-marijuana-

457690573.html

4

b. Injuries from marijuana concentrate extraction lab explosions/fires

6. Increased rates of homelessness

7. Workplace costs/costs to employers:

a. Increased absenteeism

b. More workplace accidents

Initial approximations even of these few costs indicate that it is unlikely that revenues from legalization would ever exceed its costs. This report concludes that even conservative cost estimates of only the issues above would cost Illinois approximately $670.5 million in 2020.

These projected costs are broken down as follows:

5

Table 1:

Cost center

Projected annual

cost

Percentage of

projected

revenues

($566 million*)

Regulatory costs $35.4 million 6.3%

Increased drugged driving fatalities

fatalities

$231 million 40.8%

Increased drugged driving serious injuries

$85.2 million 15.1%

Auto Damage $9.3 million 1.6%

Increased ER visits $15.5 million 2.7%

Marijuana concentrate

extraction lab

explosions

$13.3 million 2.3%

Increased homelessness

$11.9 million 2.1%

Workplace: Absenteeism

$210.4 million 37.2%

Workplace: Injuries (full-time employees)

$58.5 million 10.3%

TOTAL $ 670.5 million 118%

Plus additional, presently

unquantifiable costs

Unknown Unknown

*24/7 Wall St. estimate

6

Table 2:

7

Also, sufficient information is available to demonstrate that marijuana legalization may imply

additional costs from a variety of other sources not contemplated in this analysis, even though

data is not yet robust enough to readily quantify their impact:

• Additional workplace injuries among part-time employees

• Increases in alcohol use and abuse

• Increases in tobacco use

• More opioid abuse

• Increases in short-term/long-term recovery for marijuana use disorders

• Greater marijuana use among underage students

• Property and other economic damage from marijuana extraction lab explosions

• Controlling an expanded black market, sales to minors, and public intoxication

• Other administrative burdens of most state legalization programs, such as:

o money for drugged driving awareness campaigns;

o drug prevention programs; and

o pesticide control and other agricultural oversight mechanisms

• Long-term health impacts of marijuana use

This last issue represents a major cost of the two currently legal, addictive recreational drugs—

tobacco and alcohol. Evidence on the long-term negative health effects of marijuana use

continues to mount, even though the science on this topic can be compared to scientific

knowledge on tobacco’s health impacts in the 1930s.

Indeed, the indirect costs of such long-term health impacts represent almost half of the cost of

tobacco to the state of California,4 and it would be foolish not to acknowledge their likely impact here. Moreover, with a recent scientific study finding “evidence that chronic and heavy cannabis abuse results in long-lasting brain dysfunction in all users and in long-lasting schizophrenia-like psychotic symptoms in more than half of all users…suggest[ing] a reevaluation of the current

classification of cannabis as a ‘soft narcotic’ [emphasis added],”5 these costs could be quite significant.

8

II. Costs

A. Regulatory Costs

The first and most obvious cost of marijuana legalization is paying for the regulators who

oversee the commercialized marijuana program and who enforce various violations of legalization laws by both businesses and users (e.g., consuming marijuana in public and

enforcing licensing laws). These costs can be deceptively hard to calculate, since legalization requires not just the basic manpower to oversee the licensing apparatus, but also requires money

for public health, public safety, and agricultural agencies to pay for things like police training,

epidemiological monitoring and reporting, and pesticide and contaminant testing.6

Compiling accurate figures for all of these programs is challenging, and it is difficult to make

comparisons from state to state, since each state’s program differs from the others. Nonetheless,

the Colorado experience indicates that legalization programs generally contemplate at least a

certain baseline of activities: a licensing scheme with an attendant bureaucracy, ongoing training

for police officers, agricultural oversight of marijuana growers (including pesticide regulation

programs), programs to combat marijuana-impaired driving, and a public awareness campaign.

Even though these programs are only a portion of total legalization-related administrative costs,

this report focuses solely on these expenditures, resulting in a conservative estimate.

These basic costs totaled over $15 million in Colorado for the last complete fiscal year (FY

2015-16)7:

9

Table 3:

Program Description

Cost (FY 2015-

16)8

Percentage of revenues

($156,701,018 in FY

2015-16) 9

Marijuana Enforcement Division,

Department of Revenue (basic licensing and

enforcement)

$7,880,009 5.0%

Office of Marijuana Coordination, Office of

the Governor (policy coordination office)

$190,097 0.1%

Cannabis health environmental and

epidemiological training, outreach and

surveillance, Department of Public Health

and Environment

$320,388 0.2%

Marijuana reference library and lab testing,

Department of Public Health and

Environment

$376,434 0.2%

Public awareness marijuana education

campaign, Department of Public Health and

Environment

$4,650,000 3.0%

Pesticide control and regulation $314,633 0.2%

Peace Officers Standards and Training

Board expanded training activities,

Department of Law

$1,168,000 0.7%

Development of in-house expertise on

regulations, Department of Law

$436,766 0.3%

TOTAL $15,336,327 9.7%10

As an overall percentage of revenues, these basic administrative costs total 9.7% of total

revenues collected.

10

This is a conservative estimate, for two reasons. First, as noted above, it does not include a

significant number of the other legalization-related administrative programs in Colorado that cost

money in FY 2015-16, including but not limited to:

• Substance use screening, brief intervention, and referral treatment program, Department

of Health Care Policy and Financing: $500,000

• Expansion of program grants for prevention, Department of Human Services: $3,000,000

• School Health Professional Grant Program to address behavioral health issues in public

schools: $2,280,444

• Substance abuse and treatment contracts, Department of Human Services: $500,000

• Scientific study of marijuana law enforcement activities, Department of Public Safety: $159,983

• Poison control centers, Department of Public Health and Environment: $1,000,00011

These costs in Colorado resulting from marijuana legalization totaled $15,336,327. The ratio of the

Colorado and Illinois population is roughly 1:2.31. If we simply multiply Colorado’s $15 million

by 2.31, the grand total is $35,426,915 dollars per fiscal year for all programs due to legalization.

This represents 6.3 percent of projected revenues.

B. Increased Drugged Driving Fatalities

Marijuana legalization appears to spur large increases in driving while under the influence of marijuana. In Colorado, the percentage of all traffic fatalities in that state where the operator tested positive for marijuana use rose 48.9 percent from the year before legalization (2011) to

2015.16 And the overall number of traffic deaths related to marijuana use rose 82.5 percent over the same four-year period—63 deaths in 2011 and up to 115 in 2015. That equates to a 16.2 percent average year-over-year increase, or annual growth rate (CAGR).

𝐶𝐴𝐺𝑅 = (( 𝑓𝑖𝑛𝑎𝑙 𝑣𝑎𝑙𝑢𝑒

𝑜𝑟𝑖𝑔𝑖𝑛𝑎𝑙 𝑣𝑎𝑙𝑢𝑒 )

1# 𝑜𝑓 𝑦𝑒𝑎𝑟𝑠

) − 1

𝐶𝐴𝐺𝑅 = ((115

63)

14

) − 1 = 16.2%

11

These deaths are very expensive. The U.S. Department of Transportation values the average

human life at just over $6.6 million in 2016 dollars when calculating the economic impact of

traffic safety regulations.18

This information permits some rough calculations.19 In the case of Illinois, there were 1011

fatal crashes in 2017.20 This number is increasing by 2% each year. A report indicates

marijuana use in crashes increased by 15 percent from 2011-2015 and about 16.6 percent of car

crashes contain marijuana.

If this trend continued, Illinois would report 1076 crashes in 2020, approximately 177 of which

would involve marijuana:

Table 4:

Base scenario

Year 2016 2017 2018 2019 2020

Fatalities 1,000 1,011 1,035 1,055 1,076

Fatalities where

driver tests positive

for marijuana

164 168 171 174 177

(Roadway fatalities continue to increase at 2% annually. Numbers are

rounded to the nearest integer.)

Assuming the rate of fatal crashes involving a driver testing positive for marijuana would

increase at the same 16.2 percent average annual rate that it has in Colorado, and that legalization

is implemented in 2018, the current trend in roadway fatalities of 2 percent per year would

increase to 18.2 percent per year. That translates to 278 marijuana-related roadway fatalities in

2020, the same year for which pro-legalization activists offers their revenue projections:22

Table 5:

Legalization scenario

Year 2017 2018 2019 2020

Fatalities where driver tests positive

for marijuana

168 199 235 278

(Roadway fatalities related to marijuana use now climb at approximately 18.2

percent annually, instead of increasing at 2 percent annually. Numbers are rounded to

the nearest integer.)

Compared to the base scenario, this results in 101 additional deaths in 2020, compared to the

base scenario. 101 additional fatalities, valued at slightly more than $6.6 million per life using

U.S. Department of Transportation data, is a cost of about $666.6 million in 2016 dollars. Even if

12

Illinois is only one third of this-35 additional fatalities-the cost of these fatalities from legalizing

marijuana is $231 million. To be conservative, this report uses $231 million as the cost. That

represents 40.8 percent of projected revenues.

C. Increased Serious Injuries from Drugged Driving Crashes

One must also consider the costs of non-fatal injuries caused by increased drugged driving. There were 12,844 serious roadway injuries in Illinois in 2015, increasing at approximately 11 percent annually. Applying the same approach used in the last section, one can project numbers

for 2020 if this trend continues without marijuana legalization:24

Table 6:

Base scenario

Year 2015 2016 2017 2018 2019 2020

Serious injuries 12844 14257 15825 17566 19498 21643

Serious injuries

where driver

tests positive for

marijuana

2132 2367 2760 3063 3400 3774

(Serious traffic injuries continue to increase at 11 percent annually. Numbers are

rounded to the nearest integer.)

Assuming that the rate of change of serious traffic injuries experiences the same change as traffic

fatalities due to marijuana legalization, the number of serious injuries increases after 2017:

Table 7:

Legalization scenario

Year 2017 2018 2019 2020

Serious injuries where driver tests

positive for marijuana25

2760 3511 4466 5681

(Serious traffic injuries related to marijuana use now climb at approximately 27.2

percent annually, instead of 11 percent annually. Numbers are rounded to the nearest

integer.)

The result is an additional 1,907 serious injuries where a driver tests positive for marijuana in

2020, as compared to the base scenario. Again, to be conservative this report will include only one

third of this number. That yields an additional 636 accidents in 2020. Per AAA, the average cost

of each roadway injury (not a serious injury, but of an \verage injury),

13

is about $134,000 in 2016 dollars,26 resulting in an additional cost of $85.2 million. That

represents 15.1 percent of projected revenues.

Note that this figure does not include the cost of non-serious roadway injuries, which this report

does not consider, but will also impact the state.

D. Increased Property Damage to Vehicles from Drugged Driving

Since 2014, Illinois has also kept extensive statistics on the number of vehicles damaged in car

crashes. It is reasonable to assume that these instances of property damage will also rise when a

state legalizes recreational marijuana. Data from collision insurance claims provides a general

benchmark of $3,231 (2016 dollars) for the approximate cost of damage to a vehicle in a

roadway crash (this does not include damage to other property, such as buildings or other

structures).

In 2014, Illinois received reports of 81,498 incidents of damage to vehicles related to roadway

crashes, while in 2015 that number was 83,392, a 2.3 percent increase. Assuming this trend

continues through 2020, the state would see 93,433 total damaged vehicles in 2020. Further

assuming that, as with fatal crashes, 16.6 percent of those injuries occurred in a crash where the

driver tested positive for marijuana, this translates into 15,510 damaged vehicles:

Table 8:

Base scenario

Year 2016 2017 2018 2019 2020

Vehicles damaged in

roadway crashes

85,310 87,272 89,279 91,332 93,433

Vehicle damages in

crashes where

driver tests positive

for marijuana

14,161 14,487 14,820 15,161 15,510

(Number of vehicles damaged continues to rise at 2.3 percent annually. Numbers are rounded to the nearest integer.)

Assuming a rate of change similar to traffic fatalities and traffic injuries due to marijuana

legalization, the number of vehicles damaged in traffic crashes increases at a more rapid pace

after 2017:

14

Table 9:

Legalization scenario

Year 2017 2018 2019 2020

Vehicle damages in crashes where driver

tests positive for marijuana

14,487 17,167 20,343 24,106

(Number of vehicles damaged related to marijuana use now climb at approximately 18.5 percent

annually, instead of at 2.3 percent annually. Numbers are rounded to the nearest integer.)

The result is approximately 8,596 more damaged vehicles in 2020 related to a driver testing

positive for marijuana, as compared to the base scenario. Again, to be conservative this report

will include only one third of this number. That yields an additional 2,865 damaged vehicles in

2020. As the average cost of each damaged vehicle is about $3,231 in 2016 dollars, this results in

an additional cost of $9.3 million. This represents 1.6 percent of projected revenues.

E. Short-term health consequences

1. Increased ER visits for marijuana poisonings

Legalization of non-medical marijuana appears directly related to increases in emergency room visits related to marijuana use. Hospitalizations related to marijuana in Colorado have increased over 81.4 percent from the year prior to legalization (2011) through 2015—from 6,305 in 2011

to 11,439 in 2014.27 Thus, three years after legalization, Colorado saw 5,134 additional ER visits related to marijuana use, or about 958 new cases for each million residents, given the

state’s population at that time.28

Illinois’ current population is 12.77 million29 Conservatively assuming that this population does

not change by 2020, that yields approximately 12,234 additional marijuana-related ER visits as a

product of legalization, assuming that the same increase in ER visits per million residents in

Colorado after three years of legalization holds true in Illinois.

12.77 𝑚𝑖𝑙𝑖𝑜𝑛 𝑝𝑒𝑜𝑝𝑙𝑒 𝑖𝑛 𝐼𝐿 ∗ (958 𝑛𝑒𝑤 𝐸𝑅 𝑐𝑎𝑠𝑒𝑠 𝑝𝑒𝑟 𝑦𝑟

1 𝑚𝑖𝑙𝑖𝑜𝑛 𝑟𝑒𝑠𝑖𝑑𝑒𝑛𝑡 𝑣𝑖𝑠𝑖𝑡𝑠 𝑖𝑛 𝐼𝐿) = 12, 234 𝑛𝑒𝑤 𝐸𝑅 𝑣𝑖𝑠𝑖𝑡𝑠 𝑖𝑛 𝐼𝐿

Per a 2013 study, the median charge for an emergency room visit was approximately $1,270 in

2016 dollars.30 That results in costs of approximately $15.5 million, or about 2.7 percent of

projected revenues.

This is also likely a conservative estimate. One observational study exists that attempts to

estimate hospital costs specifically related to marijuana (not just intoxication).31 That study analyzed marijuana-related costs in a 522-bed acute care hospital facility in Colorado Springs, part of a hospital network with some of the busiest emergency rooms in the state, which sees

15

over 104,000 emergency visits annually.32 It indicates marijuana-related costs at hospitals running into the hundreds of millions of dollars per year, with individual visits reaching the

hundreds of thousands of dollars.33 A lack of more specific data makes it impossible to categorize costs by condition, but it does suggest that the above $1,270/visit estimate might lie at the low end of the possible range.

2. Marijuana concentrate extraction lab explosions

Marijuana legalization has also generated significant short-term health costs from an increase in

injuries from marijuana concentrate extraction labs. These labs use volatile solvents like butane

to extract concentrated THC from marijuana plant material, which easily pools in enclosed

spaces and can explode if a spark or flame is introduced.35 The resulting explosions not only

hurt those present, they also crease major property damage and dislocation of nearby residents or

businesses.36

In Oregon, where the state police have kept statistics on this trend, data is available on the health costs to treat those injured in extraction lab explosions, which have also occurred in legal

marijuana business, despite regulation.37 In the first twelve months after retail legalization (July

2015 – July 2016), the number of burn victims from marijuana concentrate extraction increased from seven to 30, and the associated health care costs for these victims also increased by $4.1

million, from $1.1 million to $5.2 million.38 This reversed a downward trend, as seen in the graphic below:

Graphic from Oregon State Police. Note how costs declined from 2013-2014 but then rose

sharply the following year when non-medical use was legalized.

13

This increase in cost translates into approximately one dollar per resident of the state—costs

increased by $4.1 million, and Oregon’s population in 2016 was 4.093 million.39 Much of those

costs had to be paid from Medicare and Medicaid funds.40

To arrive at a rough projection of total costs in Illinois extraction lab explosions seen in just one

year in Oregon will occur during the period 2018-2020 in Illinois, and assume that the state’s

population remains stable at approximately 12.7 million people,41 that translates into a cost in

2020 of $13.3 million, or about 2.3 percent of projected revenues.

Moreover, the above figure does not include the costs of property damage, dislocation/relocation of any residents or businesses occupying the buildings where the explosions occurred, or other economic losses. Some of these losses are significant. For example, an extraction lab explosion in an apartment building in Washington state resulted in over $2 million in property damage and

the death of a neighbor.42 A similar blast in Washington state produced about $100,000 in

property damage.43 A third lifted the building containing the lab six inches off its foundations,

creating an unspecified amount of property damage.44

F. Increased Homelessness

Another documented problem in post-legalization Colorado is a strong uptick in the homeless

population. Denver saw its monthly homeless shelter usage increase by 50 percent post-

legalization (July 2012 to November 2015 (Citation forthcoming in next version). Shelter

workers estimate that 20 to 30 percent of these new arrivals are there due to the state’s

marijuana policies—or about 10 to 15 percentage points of the 50-point increase. To be

conservative, this report assumes that only about one quarter of the increase is a direct

consequence of legalization, or three percent over three and a third years.

𝐶𝐴𝐺𝑅 = ((1.03)1

3.33) − 1 = 0.0089 = 0.89% 𝑎𝑣𝑒𝑟𝑎𝑔𝑒 𝑖𝑛𝑐𝑟𝑒𝑎𝑠𝑒 𝑝𝑒𝑟 𝑦𝑒𝑎𝑟

A rough estimate of the additional costs of homelessness stemming from legalization can be

calculated using the Colorado trend. Illinois’ homeless population was 10,798 in 2017 (Citation

forthcoming in next version) Assuming that the Colorado trend will manifest itself in Illinois, and

that shelter usage is a useful proxy for homelessness, one can calculate that in 2020, the homeless

population will include 291 more people than it would have without legalization.

𝐼𝑛𝑐𝑟𝑒𝑎𝑠𝑒 𝑖𝑛 ℎ𝑜𝑚𝑒𝑙𝑒𝑠𝑠 𝑑𝑢𝑒 𝑡𝑜 𝑙𝑒𝑔𝑎𝑙𝑖𝑧𝑎𝑡𝑖𝑜𝑛= 𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 ℎ𝑜𝑚𝑒𝑙𝑒𝑠𝑠 𝑖𝑛 2017 ∗ ((1 + 𝐶𝐴𝐺𝑅)# 𝑜𝑓 𝑦𝑒𝑎𝑟𝑠 − 1) = 10,798 ∗ (1.00893 − 1)= 291 𝑎𝑑𝑑𝑖𝑡𝑖𝑜𝑛𝑎𝑙 ℎ𝑜𝑚𝑒𝑙𝑒𝑠𝑠 𝑝𝑒𝑟𝑠𝑜𝑛𝑠 𝑖𝑛 2020 𝑑𝑢𝑒 𝑡𝑜 𝑙𝑒𝑔𝑎𝑙𝑖𝑧𝑎𝑡𝑖𝑜𝑛

14

The social cost of homelessness is not trivial. In Colorado, the cost is estimated at $45,183 per

homeless person per year in 2016 dollars, to cover costs from emergency care to shelter to legal

issues (Citation forthcoming in next version). In Rhode Island, estimates are similar—approximately

$36,594 per homeless person per year in 2016 dollars. (Citation forthcoming in next version)

291 ∗ $40,889 = $11.90 𝑚𝑖𝑙𝑙𝑖𝑜𝑛

This yields a cost of $11.9 million, or 2.1 percent of total projected marijuana revenues.

G. Workplace costs

According to the National Council on Alcoholism and Drug Dependence (NCADD), illegal drug

use is responsible for annual economic losses of over $80 billion.55 As marijuana is by far the most widely used illegal drug, it is unsurprising that its use would trigger significant losses on its

own.56

Unlike cigarettes, marijuana’s psychoactive properties intoxicate and create tangible problems in

the workplace. A peer-reviewed study of thousands of employees indicated that marijuana users

were unjustifiably absent from work 77 percent more often than non-users, and had a rate of

workplace injuries 85 percent higher than that control group.58 (They were also involved in

workplace disciplinary incidents as a rate 55 percent higher than the control group,59 but there is

less data available to quantify the costs of such behavior on employers’ bottom line.)

Data from the National Drug Use and Health (NSDUH), the nation’s premier annual survey on

drug, alcohol, and tobacco use, supports this conclusion. Per the 2014 NSDUH, the last year for

which detailed survey data is currently available, people who used marijuana in the last month

were, even when controlling for alcohol use:

• 40 percent more likely to have missed at least one day of work in the last month due to

injury or sickness; and

• 106 percent more likely—that is, more than twice as likely—to have missed at least one

day of work in the last month because they “just didn’t want to be there.”60

15

19

1. Absenteeism

Unscheduled absenteeism in the general workforce has a defined price tag; a 2005 study reported

an average cost of $2,652 in unscheduled absenteeism costs for the average salaried worker, and

$3,591 in such costs for the average part-time worker.61 In 2016 dollars, that translates to $3,258

and $4,412, respectively.

The total Illinois employed labor force at the end of 2017 was 6,500,400. To be conservative for

the purposes of this section’s cost analysis, this report assumes that all such employees were

salaried, since absenteeism for full-time employees is less costly than for part-time employees.

The report also assumes that last-month marijuana use is a good indicator for people likely to

test positive for marijuana use in the workplace. Per the NSDUH, the marijuana use rate among

those 18 years old and up (those most likely to be in the workforce) has increased an average of 15.0 percent per annual period in Colorado from 2012-13 to 2014-15.63

(17.12% 𝑢𝑠𝑒 𝑟𝑎𝑡𝑒 𝑖𝑛 2014 − 15

12.86% 𝑢𝑠𝑒 𝑟𝑎𝑡𝑒 𝑖𝑛 2012 − 13)

12

− 1 = 15.4% 𝑎𝑣𝑔. 𝑖𝑛𝑐𝑟𝑒𝑎𝑠𝑒 𝑖𝑛 𝑢𝑠𝑒 𝑟𝑎𝑡𝑒 𝑝𝑒𝑟 𝑝𝑒𝑟𝑖𝑜𝑑

In Illinois, 8.03% of people ages 18 and up have used marijuana in the past month. If one

assumes that (a) this use rate stays stable through the theoretical beginning of legalization in

2018, and (b) the use rate will then increase for this age group in Illinois post-legalization at the

same rate that it did in Colorado, one can estimate that in 2020, the use rate for ages 18 and up

will be 10.33 percent in 2020, an increase of 2.3 percentage points.

Conservatively assuming that of these additional last-month marijuana users, only one in every

two (1.15 percent of the total workforce) start to use marijuana in a way that creates absenteeism

problems, that translates into 83,855 additional employees with absenteeism problems.

6,500,400 𝑒𝑚𝑝𝑙𝑜𝑦𝑒𝑒𝑠 ∗ .0129 = 83,855 𝑎𝑑𝑑′𝑙 𝑒𝑚𝑝𝑙𝑜𝑦𝑒𝑒𝑠 𝑤𝑖𝑡ℎ 𝑎𝑏𝑠𝑒𝑛𝑡𝑒𝑒𝑖𝑠𝑚 𝑝𝑟𝑜𝑏𝑙𝑒𝑚𝑠 If these employees, per the academic study cited above, have absenteeism rates 77 percent higher

than their non-using colleagues, that means that they are responsible for additional absenteeism

costs of $2,509 per employee per year ($3,258 * 0.77 = $2,509). That yields a total of $210.4

million annually, or 37.2 percent of total projected revenues.

83,855 𝑒𝑚𝑝𝑙𝑜𝑦𝑒𝑒𝑠 ∗$2,509 𝑒𝑚𝑝𝑙𝑜𝑦𝑒𝑒

𝑦𝑒𝑎𝑟= $210,392,190 𝑚𝑖𝑙𝑖𝑜𝑛

20

2. Marijuana-related workplace injuries (full-time employees)

As noted above, marijuana users are also 85 percent more likely to suffer workplace injuries than

non-users,64 and thus the increase in expected marijuana use post-legalization among the

working-age population is also likely to result in more workplace injuries, both fatal and non-

fatal.

Illinois averages 3.2 cases of non-fatal workplace injuries and illnesses per every 100 full-time

workers. On a national level, due to increasingly good worker safety practices, the rate of non-

fatal injuries has been slowly falling, at about 2.5 percent per year on average from 2010 to

2015, the last year federal data is available. That means by 2020, the rate will have reached

2.38 injuries per year per 100 full-time workers:

Table 10:

Base scenario

Year 2015 2016 2017 2018 2019 2020

Injuries per 100 full-

time workers

3.2 3.12 3.04 2.96 2.89 2.82

(Average decrease of 2.5 percent per year.)

An 85 percent increase in injury rates for marijuana users means that the subset of employees

post-legalization that start using marijuana will be responsible for an additional 2.39 injuries for

every 100 full-time workers.

(2.8 𝑖𝑛𝑗𝑢𝑟𝑖𝑒𝑠

𝑦𝑒𝑎𝑟 )

100 𝑤𝑜𝑟𝑘𝑒𝑟𝑠∗ 85% = 2.38 𝑎𝑑𝑑𝑖𝑡𝑖𝑜𝑛𝑎𝑙 𝑖𝑛𝑗𝑢𝑟𝑖𝑒𝑠 𝑝𝑒𝑟 100 𝑤𝑜𝑟𝑘𝑒𝑟𝑠 𝑝𝑒𝑟 𝑦𝑒𝑎𝑟

Illinois has about 6,500,400 current employees. In 2016, the U.S. workforce was approximately

81.7 percent full-time,67 and in the absence of state data, it is reasonable to assume that the same proportion holds in Illinois, yielding 5,310,827 full-time employees.

Referring to the sub-section above, one can assume that by 2020, legalization in Illinois will

result in a 1.15% percentage point increase in the number of monthly marijuana users ages 18

and up. Again, to be conservative, let us assume that just a half of these new monthly marijuana

users, or 1.79 percent of the total workforce, will use marijuana in a manner that places them at

greater risk for an injury.

This means that in 2020, about 61,075 workers ((6,500,400 total full-time workers * .817)*)

will be injured at this higher rate as a result of legalization. They will have, on average, an

additional 2.39 injuries annually for every 100 workers, or 226 additional injuries.

21

6,500,400 𝑓𝑢𝑙𝑙 𝑡𝑖𝑚𝑒 𝑤𝑜𝑟𝑘𝑒𝑟𝑠 𝑖𝑛 𝐼𝐿 ∗ 2.2% = 9,426 𝑤𝑜𝑟𝑘𝑒𝑟𝑠

61,075 𝑤𝑜𝑟𝑘𝑒𝑟𝑠 ∗(

2.38 𝑖𝑛𝑗𝑢𝑟𝑖𝑒𝑠𝑦𝑒𝑎𝑟 )

100 𝑤𝑜𝑟𝑘𝑒𝑟𝑠= 1,454 𝑎𝑑𝑑𝑖𝑡𝑖𝑜𝑛𝑎𝑙 𝑖𝑛𝑗𝑢𝑟𝑖𝑒𝑠

Per the National Safety Council, each additional workplace injury costs, on average,

approximately $40,210 in 2016 dollars, including wage losses, medical expenses, administrative

expenses, and employer costs (property damage is excluded).68 Thus, 1,454 additional

workplace injuries annually yield a total cost of $58.5 million. That, taken alone, represents

10.3 percent of the total projected revenues.

Finally, note again that this figure only addresses full-time employees. Additional injuries

among part-time employees, almost 20 percent of the total workforce, are not included here.

H. Additional information regarding costs

1. Long-term health effects

Evidence on the long-term negative health effects of marijuana use continues to mount, even

though the science on this topic can be compared to scientific knowledge on tobacco’s health

impacts in the 1930s. For example, in January 2017, The National Academy of Sciences (NAS),

issued a landmark report written by top scientists, The Health Effects of Cannabis and

Cannabinoids: Current State of Evidence and Recommendations for Research. The report

reviewed over 10,000 peer-reviewed academic articles and concluded that marijuana use is

connected to, among other problems:

• respiratory problems;

• mental health issues (like psychosis, social anxiety, and thoughts of suicide);

• increased risk of car accidents;

• progression to and dependence on other drugs, including studies showing connections

to cocaine and heroin use;

• learning, memory, and attention loss (possibly permanent in some cases);

• suicidal ideation (thoughts of suicide); and

• low birth weight.69

Similarly, a December 2016 report by the office of the U.S. Surgeon General, highlights the

dangers of marijuana use and stands as a further warning of the large impending public

health costs of marijuana legalization policies. Among the report’s findings:

• Long-term health consequences of marijuana use: mental health problems, chronic

cough, frequent respiratory infections, increased risk for cancer, and suppression of the

immune system.

• Other serious health-related issues stemming from marijuana use: breathing

problems; increased risk of cancer of the head, neck, lungs, and respiratory tract; possible

loss of IQ points when repeated use begins in adolescence; babies born with problems

with attention, memory, and problem solving (when used by the mother during

pregnancy).

• Increased risk for traffic accidents: Marijuana use “is linked to a roughly two-fold

increase in accident risk.”

• Increased risk of schizophrenia: “[T]he use of marijuana, particularly marijuana with a

high THC content, might contribute to schizophrenia in those who have specific genetic

vulnerabilities.

• Increased risk of addiction from high-potency marijuana available in legalized

states: “[C]oncern is growing that increasing use of marijuana extracts with extremely high amounts of THC could lead to higher rates of addiction among marijuana users.”

• Permanent Loss of IQ: “One study followed people from age 13 to 38 and found that those who began marijuana use in their teens and developed a persistent cannabis use

disorder had up to an eight-point drop in IQ, even if they stopped using in adulthood.”70

In some cases, the costs can be extremely high. A recent study published by the Journal of

Psychiatric Research found that marijuana-dependent Iraq/Afghanistan-era veterans have an

increased risk of suicidal thoughts and attempted suicide. More than 3,000 veterans were

sampled, and the study design also controlled for factors including PTSD, depression, alcohol

dependence, and other drug disorders:71

17

Iraq/Afghanistan-era veterans with cannabis use disorder attempted suicide at over twice the

rate of the control group, even when controlled for PTSD, depression, alcohol dependence, and

other drug disorders, among other factors.

This study expands on the aforementioned National Academies of Sciences report, which found only limited evidence that marijuana or cannabinoids could be effective in treating symptoms of

PTSD.72 In fact, the NAS report revealed a stronger association between marijuana use and

social anxiety disorders, depressive disorders, and schizophrenia.73 A 2015 Yale University

study also showed a connection between marijuana use and PTSD symptoms.74

18

Although science on marijuana is not nearly well-developed enough to create cost models for

long-term use similar to those with tobacco (such as this exhaustive 2014 University of

California, San Francisco study on the costs of tobacco use in California), the existing science

already casts a long shadow. Indirect costs from long-term negative effects of smoking

accounted for almost one-half of the total cost of smoking to the state in that study, suggesting

that similar dynamics may well exist with marijuana.75

Additionally, an increasingly large body of evidence suggests that heavy marijuana use can have serious long-term effects. A 2017 study found “evidence that chronic and heavy cannabis abuse results in long-lasting brain dysfunction in all users and in long-lasting schizophrenia-like psychotic symptoms in more than half of all users…suggest[ing] a reevaluation of the current

classification of cannabis as a ‘soft narcotic’ [emphasis added].”76 And another study in 2016 found that men who had begun using marijuana heavily in their late teens were 40 percent more

likely to die by the time they reached 60 compared to those who had not used the drug. 77 This correlation remained even after controlling for confounding factors such as alcohol use, mental

illness, and social problems.78

The fact that marijuana use is associated with a wide spectrum of both physical and mental

health problems is ominous in terms of long-term health care costs. Any cost study should at

least acknowledge that such long-term health costs are likely to occur and are likely to be large,

even if they cannot readily be quantified at present.

2. Other costs

As noted in the introduction, additional costs of marijuana legalization in Colorado and

Washington state have been identified, even though insufficient data exists to attempt to quantify

them. These include, but are not limited to:

• Additional workplace injuries among part-time employees:

As noted above, this report only estimates the additional cost of workplace injuries

among full-time employees. Additional injuries among part-time employees—which

constitute almost 20 percent of the workforce—are an additional burden.

• Increases in alcohol use and abuse:

Despite rhetoric to the contrary, alcohol consumption has risen slightly in Colorado after

legalizing marijuana in 2012.79 This is unsurprising: many marijuana users like using

the drug along with alcohol, instead of as a substitute, and those who use both substances

are twice as likely to use both at the same time, rather than just one.80 Those who

smoked pot and drank at the same time were 2.3 times more likely to have driven drunk,

three times more likely to have dealt with social consequences as a result of their

drinking, and more than twice as likely to have experienced other social harms like

19

fighting and relationship problems as compared to those who only consume alcohol.81

The marijuana industry’s response to this demand has been to move rapidly to develop

alcoholic beverages that contain THC.82 The CEO of large alcohol company

Constellation Brands, Inc., which owns the Svedka vodka and Corona beer brands

recently announced that “We’re looking at it … There are going to be alcoholic

beverages that will also contain cannabis.”83

Additionally, marijuana use increases the risk of alcoholism, with all of its associated social costs. A 2016 study of over 27,000 adults showed that marijuana users are five times more likely to develop an alcohol use disorder compared to non-users, and are

more likely to see that problem persist.84 This was true even among marijuana users that

did not have any history of problems with alcohol use.85

• Increases in tobacco use:

Evidence is also mounting that marijuana use is associated with tobacco use disorders,

including the seminal 2017 National Academies of Sciences report on marijuana.86 And

public health experts warn that the marijuana industry’s push to relax smoking laws, such

as Denver’s new law allowing marijuana smoking in restaurants and cafés, could

encourage rises in tobacco use, as well.87

• More opiate abuse:

Marijuana use is also closely linked with opiate abuse and its attendant costs. More than

four in 10 people who ever use marijuana will go on to use other illicit drugs, per a large,

nationally representative sample of U.S. adults.88 And according to the Centers for

Disease Control (CDC), marijuana users are three times more likely to be addicted to

heroin than non-users.89

Prescription opioid abuse among marijuana users is also a problem. The National Academy of Sciences found that “with regard to opioids, cannabis use predicted continued opioid prescriptions 1 year after injury… marijuana use was [also] associated with reduced odds of achieving abstinence from alcohol, cocaine, or polysubstance use

after inpatient hospitalization and treatment for substance use disorders.”90 And another study indicated that women who use marijuana during methadone treatment are far more

likely to continue using opioids than those who do not.91

• Increases in short-term/long-term recovery for marijuana use disorders

The percentage of people in drug treatment for marijuana use in Colorado reporting

heavy use of the drug (more than 21 days per month), increased from 30% in 2011 (pre-

legalization) to 36% in 2014.92 It is to date unclear what the costs of such heavy use will

20

21

be, such as longer stays in treatment facilities or relapses, but the trend is a concern.

• Greater marijuana use among underage students:

Since legalization, marijuana offenses in Colorado elementary and high schools have

increased 34 percent in the first two years since legalization, resulting in almost 600 such

new cases.93 The economic cost of these problems at school is unknown, but is certainly

greater than zero.

Moreover, daily marijuana users under age 17 were 60 percent more likely to drop out of

high school than teens who did not use marijuana.94 According to a 2011 study, the lifetime cost to society of a high school dropout is estimated at just over $1 million in

2016 dollars—$251,526 in fiscal costs and $751,355 in indirect social impacts.95

• Secondhand smoke exposure:

The effects of secondhand marijuana smoke exposure are not nearly as well-known as

those of tobacco smoke, but an initial study indicates that it may be at least as harmful to

cardiovascular function.96 These costs are not included in the analysis above.

Secondhand tobacco smoke exposure results costs U.S. society about $5.6 billion per

year in lost productivity alone.97

• Property and other economic damage from marijuana extraction lab explosions:

As noted above, the cost of marijuana extraction lab accidents include, but are not

confined to, medical expenses. They also often include extensive property damage and

other economic consequences stemming from it, such as relocation of residents, which

can run into the millions of dollars per incident.

• Controlling an expanded black market, use by minors, and public intoxication:

An increase in the number of marijuana extraction lab explosions is just one indicator of expanded black market activity that requires public resources. New data from Oregon, which legalized marijuana in 2014, shows that 70 percent of marijuana market activity is

illegal—more than two of every three transactions.98 Comments by the Colorado

Attorney General indicate a similar dynamic in that state.99 Indeed, recent reports suggest Mexican drug traffickers are using Colorado’s lax marijuana laws to relocate

marijuana growing operations from Mexico to Colorado.100

Moreover, as consumption levels among minors has risen, so has the need to enforce the

law surrounding underage possession and use. In the two years following legalization in

Colorado, the number of minors arrested for using marijuana increased five percent.101

22

Citations for public use of marijuana—also illegal even under legalization—have also

risen in Colorado.102

Controlling all of these phenomena can cost significant state resources, none of which are

considered in pro-legalization activists’ proposals.

• Other administrative costs of state legalization programs:

As noted above, administrative costs for state legalization initiatives extend far beyond paying the employees of the principal regulatory bodies. Many states that have legalized the drug also spend significant sums on other enforcement-related programs such as meeting an expanded need for

substance abuse and treatment.103 These costs are significant, but are not included here.

III. Conclusion

Even under this conservative scenario, and omitting important cost centers such as long-term

health costs, marijuana legalization will cost Illinois approximately $670.5 million in 2020, 118

percent more than the $566 million in revenues that pro-legalization activists project.

23

Table 11:

Cost center

Projected annual

cost

Percentage of

projected

revenues

($566 million*)

Regulatory costs $35.4 million 6.3%

Increased drugged driving fatalities

fatalities

$231 million 40.8%

Increased drugged driving serious injuries

$85.2 million 15.1%

Auto Damage $9.3 million 1.6%

Increased ER visits $15.5 million 2.7%

Marijuana concentrate

extraction lab

explosions

$13.3 million 2.3%

Increased homelessness

$11.9 million 2.1%

Workplace: Absenteeism

$210.4 million 37.2%

Workplace: Injuries (full-time employees)

$58.5 million 10.3%

TOTAL $ 670.5 million 118%

Plus additional, presently

unquantifiable costs

Unknown Unknown

*24/7 Wall St. estimate

24

Illinois’ employers will shoulder a significant portion of these costs—those from additional

workplace injuries and absenteeism.

Finally, it warrants repeating that the above numbers represent a very conservative model, and do

not include a large list of likely cost centers, including:

• Additional workplace injuries among part-time employees

• Increases in alcohol use and abuse

• Increases in tobacco use

• More opioid abuse

• Increases in short-term/long-term recovery for marijuana use disorders

• Greater marijuana use among underage students

• Property and other economic damage from marijuana extraction lab explosions

• Controlling an expanded black market, sales to minors, and public intoxication

• Other administrative burdens of most state legalization programs, such as:

o money for drugged driving awareness campaigns;

o drug prevention programs; and

o pesticide control and other agricultural oversight mechanisms

• Long-term health impacts of marijuana use

Not the least of these additional costs are the long-term health consequences of marijuana use,

which remain largely unknown. Illinois lawmakers should bear these economic costs in mind

when considering marijuana legalization proposals—not just projected revenues. What seems

like a good deal when considering revenues alone is likely a money-loser for the state when

costs are included.

###

1Centers for Disease Control and Prevention. Economic Trends in Tobacco. (2017, March 03). Retrieved March

2017, from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/economics/econ_facts/; Campaign for Tobacco- Free Kids. (2017). State Tobacco-Prevention Spending vs. State Tobacco Revenues and Annual Smoking- Caused

Health Costs. Retrieved from https://www.tobaccofreekids.org/research/factsheets/pdf/0219.pdf 2 Nestoros, J. N., Vakonaki, E., Tzatzarakis, M. N., Alegakis, A., Skondras, M. D., & Tsatsakis, A. M. (2017,

March). Long lasting effects of chronic heavy cannabis abuse. The American Journal on Addictions. Wiley-

Blackwell. https://doi. org/10.1111/ajad.12529 3 Silbaugh, L. (2016). Distribution of Marijuana Tax Revenue (04th ed., Vol. 16, Issue brief). CO: Colorado

Legislative Council. https://www.colorado.gov/pacific/sites/default/files/16-

04%20Distribution%20of%20Marijuana%20Tax%20Revenue%20Updated_2.pdf. 4 Colorado’s fiscal year runs from July 1 of every year to June 30 of the following year. See State of Colorado -

Contract Management System - Powered By: Cobblestone Systems Corp. Retrieved March 29, 2017, from

http://contractsweb.state.co.us/. 5 Silbaugh, L. (2016). Distribution of Marijuana Tax Revenue (04th ed., Vol. 16, Issue brief). CO: Colorado

Legislative Council. https://www.colorado.gov/pacific/sites/default/files/16-

04%20Distribution%20of%20Marijuana%20Tax%20Revenue%20Updated_2.pdf. 6 Colorado Department of Revenue. Marijuana Tax Data. Retrieved March 21, 2017, from

https://www.colorado.gov/pacific/revenue/colorado-marijuana-tax-data (taxes and license fees). 2 As in the rest of this document, individual percentages may not add up exactly to the total due to rounding. Here,

15,336,327 of 156,701,018 is 9.8%, not 9.7%, as would be calculated by adding up the percentages rounded to one

decimal place. 3 Silbaugh, L. (2016). Distribution of Marijuana Tax Revenue (04th ed., Vol. 16, Issue brief). CO: Colorado

Legislative Council. https://www.colorado.gov/pacific/sites/default/files/16-

04%20Distribution%20of%20Marijuana%20Tax%20Revenue%20Updated_2.pdf.

24

4 United States Census Bureau. (2017). QuickFacts: Population. Web. 23 Mar. estimates, July 1, 2017. Retrieved

March 1, 2018, retrieved from https://www.census.gov/quickfacts/fact/table/IL,CO/PST045217#viewtop. 5 http://www.accountingtools.com/questions-and-answers/what-is-fixed-overhead.html 6 AAA Foundation for Traffic Safety. Prevalence of Marijuana Involvement in Fatal Crashes: Washington, 2010-

2014. May 2016. Retrieved from:

https://www.aaafoundation.org/sites/default/files/PrevalenceOfMarijuanaInvolvement.pdf. 7 Id. 8 Fatality Analysis Reporting System and Colorado Department of Transportation (CDOT), as reported in Rocky

Mountain HIDTA Investigative Support Center Strategic Intelligence Unit. The Legalization of Marijuana in

Colorado: The Impact, Volume 4. Sept. 2016. Retrieved from

http://www.rmhidta.org/html/2016%20FINAL%20Legalization%20of%20Marijuana%20in%20Colorado%20The%

20Impact.pdf. This report also assumes, with respect to the various cost centers analyzed here, that the baseline for

costs is the time period just prior to recreational legalization. Colorado, Washington state, Oregon, and Rhode

Island have all had medical marijuana programs in place for over a decade (2000, 1998, 1998, and 2006,

respectively), and as much purported medical use in many of those states was de facto recreational use, the situation

just prior to the passage recreational legalization laws serves as a reasonable baseline for their impact. 9 Id. 10 U.S. Department of Transportation (2011), "Treatment of the Economic Value of a Statistical Life in

Departmental Analyses – 2011 Interim Adjustment”. Retrieved from: https://www.transportation.gov/sites/dot.gov/files/docs/Value_of_Life_Guidance_2011_Update_07-29-2011.pdf.

($6.2 million in 2011 dollars. (The median jury verdict for wrongful death is somewhat lower, at around $1 million,

but this number is generalized for all wrongful deaths, does not focus on roadway fatalities specifically, and does not

have any specific scientific grounding. Sunstein, C., Posner, E., (2004) "Dollars and Death" John M. Olin Program

in Law and Economics Working Paper No. 222. Retrieved from:

http://chicagounbound.uchicago.edu/law_and_economics/182/.) This valuation is in line with an American

Automobile Association estimate of approximately $6.4 million in 2016 dollars. Copeland, Larry. "AAA: Fatal

motor vehicle crash costs $6 million." USA Today 3 Nov. 2011 Retrieved from

https://usatoday30.usatoday.com/news/nation/story/2011-11-02/fatal-vehicle-crashes-cost-millions/51051030/1. 11 It is, of course, difficult to distinguish between correlation and causation. Nonetheless, a string of strong

correlative relationships is certainly sufficient to inform policy decisions. Evidence proving that tobacco smoking definitively caused lung cancer was only available in the 1990s, long after it had become clear the two were closely

intertwined, and U.S. society began to curtail the practice. (Indeed, it was the tobacco industry, whose profits were

bound up in concealing this relationship, that fought most strenuously to denigrate evidence of harms as “merely

correlation.” Given the science showing how marijuana use impairs driving, it does not strain credulity—or

common-sense—to place confidence in evidence showing a correlation between marijuana legalization and

increased drug-impaired driving. 12 National Highway Traffic Safety Administration (2017). Rhode Island Highway Safety Plan FY 2017. Retrieved

from: https://one.nhtsa.gov/links/StateDocs/FY17/FY17HSPs/RI_FY17HSP.pdf. 13 Id. 14 The average annual rate of increase would be estimated at 12.6 percent, or 16 percent minus the current trend of -

3.4 percent per year. But one must count as additional costs the deaths that would have been averted by current

highway safety policies absent legalization, as well, meaning that the full 16 percent increase should be considered. 23 Hartman RL, Huestis MA. (2013). Cannabis effects on driving skills. Clinical Chemistry59(3):478-492.

doi:10.1373/clinchem.2012.194381; Hartman RL, Brown TL, Milavetz G, et al. (2015) Cannabis effects on driving lateral control with and without alcohol. Drug Alcohol Dependency. 154:25-37. doi:

10.1016/j.drugalcdep.2015.06.015. 24 National Highway Traffic Safety Administration (2017). Rhode Island Highway Safety Plan FY 2017. Retrieved

from: https://one.nhtsa.gov/links/StateDocs/FY17/FY17HSPs/RI_FY17HSP.pdf.

25

25 Again, numbers in the text may vary slightly due to rounding. 26 Copeland, Larry. "AAA: Fatal motor vehicle crash costs $6 million." USA Today 3 Nov. 2011 Retrieved from

https://usatoday30.usatoday.com/news/nation/story/2011-11-02/fatal-vehicle-crashes-cost-millions/51051030/1. 27 CO Hospital Association and CO Dept. of Public Health and Environment, as reported in Rocky Mountain

HIDTA Investigative Support Center Strategic Intelligence Unit. (2016). The Legalization of Marijuana in

Colorado: The Impact, Volume 4. Sept. 2016. 28 Colorado’s population was about 5.356 million in mid-2014. See

Svaldi, A. (2015, December 22). Colorado’s population jumped by 101,000 in 12 months. Denver Post. Retrieved

from http://www.denverpost.com/2015/12/22/colorados-population-jumped-by-101000-in-12-months/. 29 United States Census Bureau (2017). Population estimates, July 1, 2016. Retrieved March 20, 2017, from

https://www.census.gov/quickfacts/table/PST045215/44. 30 Caldwell, Nolan et al. (2013) “‘How Much Will I Get Charged for This?’ Patient Charges for Top Ten Diagnoses

in the Emergency Department.” Ed. Harry Zhang. PLoS ONE 8.2 (2013): e55491. PMC. Web. 22 Mar. 2017. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584078/. 31 Finn, K., Salmore, R., (2010). The Hidden Costs of Marijuana Use in Colorado: One Emergency Department’s

Experience. The Journal of Global Drug Policy and Practice. Retrieved from:

http://globaldrugpolicy.org/Issues/Vol%2010%20Issue%202/Articles/The%20Hidden%20Costs%20of%20Marijuana%20Use%20in%20Colorado_Final.pdf. 32 Id. 33 Id. 34 See A Baseline Evaluation of Cannabis Enforcement Priorities in Oregon (Rep.). (2017). OR: Oregon State

Police-Drug Enforcement Section. Retrieved from https://mass-cannabis-control.com/wp-content/uploads/2017/12/A-Baseline-Evaluation-of-Cannabis-Enforcement-Priorities-in-Oregon_.pdf. (commenting that significant portions of health care costs from lab explosions in Oregon had to be paid out of

public Medicare and Medicaid funds). 35 House explosion illustrates hash oil danger. (2016, December 8). WoodTV8. Retrieved from

http://woodtv.com/2016/12/08/house-explosion-illustrates-hash-oil-danger/. 36 12 News, Man seriously injured when butane hash lab sparks home fire. (2017, February 26). Retrieved March

2017, from http://www.12news.com/article/news/local/arizona/man-seriously-injured-when-butane-hash-lab-sparks-home-fire/414657213. 37 Crombie, N. (2016, October 20). Blast rocks legal marijuana business in Astoria, sends 2 to burn unit. The

Oregonian/Oregon Live. Retrieved from

http://www.oregonlive.com/marijuana/index.ssf/2016/10/blast_rocks_legal_marijuana_bu.html. Similar statistics

are seen in Colorado. The state had 32 confirmed extraction lab explosions, and 30 related injuries in 2014, two

years post-legalization, up from 12 explosions and 18 injuries just the year before. Coe-Harris, J. (2016, April 17).

Marijuana — BHO explosions on the rise. The Daily Reporter. Retrieved from

http://www.thedailyreporter.com/news/20160417/marijuana---bho-explosions-on-rise 38 A Baseline Evaluation of Cannabis Enforcement Priorities in Oregon (Rep.). (2017). OR: Oregon State Police-

Drug Enforcement Section. Retrieved from https://mass-cannabis-control.com/wp-content/uploads/2017/12/A-Baseline-Evaluation-of-Cannabis-Enforcement-Priorities-in-Oregon_.pdf. 39 United States Census Bureau (2017). Population estimates, July 1, 2016. Retrieved March 20, 2017, from

https://www.census.gov/quickfacts/table/PST045216/41. Oregon’s population in 2016 was 4.093 million - 40 A Baseline Evaluation of Cannabis Enforcement Priorities in Oregon (Rep.). (2017). OR: Oregon State Police-

Drug Enforcement Section. Retrieved from https://mass-cannabis-control.com/wp-content/uploads/2017/12/A-Baseline-Evaluation-of-Cannabis-Enforcement-Priorities-in-Oregon_.pdf. United States Census Bureau (2017). Population estimates, July 1, 2015. Retrieved March 20, 2017, from

https://www.census.gov/quickfacts/table/PST045215/44.

26

41 Johnson, G., Man sentenced to 9 years in fatal Bell. (2015, June 7). Komo News. Retrieved from

http://komonews.com/news/local/man-sentenced-to-9-years-in-fatal-bellevue-hash-oil-blast. (According to media

reports, one of the men responsible later stated in a court filing, “’I only got involved in this because I thought that

the legalization movement of marijuana in Washington would provide me with funds to be a part of my boys [sic]

lives, and it went so far in the opposite direction I can't think of it without crying, or having a panic attack. Looking

back and seeing the percentage that marijuana took up of my life makes me sick.’”) 42 Seattle Times Staff. 2 Sentenced to federal prison for Kirkland hash oil explosion. (2015, March 3). Seattle Times.

Retrieved from https://www.seattletimes.com/seattle-news/2-sentenced-to-federal-prison-for-kirkland-hash-oil-explosion/.

43 Sullivan, J. (2014, January 7). Powerful Mount Baker Explosion blamed on. The Seattle Times. Retrieved from: http://blogs.seattletimes.com/today/2014/01/powerful-blast-rocks-mount-baker-apartment-building/ 43 U.S. Department of Justice. Dangers of Butane Hash Oil Labs Cited as Five are Charged. (2016, March 30).

Retrieved March 2017, https://www.justice.gov/usao-ri/pr/dangers-butane-hash-oil-labs-cited-five-are-charged.

44 McGowan, D. (2015, September 28). Email: EDC lawyer pushed family property for 38 Studios HQ. Retrieved

March 29, 2017, from http://wpri.com/2015/09/28/email-edc-lawyer-pushed-family-property-for-38-studios-hq/. 44 U.S. Department of Justice. Dangers of Butane Hash Oil Labs Cited as Five are Charged. (2016, March 30).

Retrieved March 2017, from https://www.justice.gov/usao-ri/pr/dangers-butane-hash-oil-labs-cited-five-are-charged. 47 Nagle, K. (2015, March 10). Marijuana Growing Facilities “Serious Concern,” Says RI Fire Marshal. Retrieved

March 29, 2017, from http://www.golocalprov.com/news/marijuana-growing-facilities-serious-concern-says-ri-fire-

marshal. 48 Warner, Joel. (2016) “Marijuana Legalization in Colorado: How Recreational Weed Is Attracting People, But

Spiking the State’s Homeless Rate.” International Business Times. 20 June 2016. Retrieved from:

http://www.ibtimes.com/marijuana-legalization-colorado-how-recreational-weed-attracting-people-spiking-2374204. 49 Id. 50 DePillis, L. (2014, August 8). Why Denver is trucking its homeless to the middle of nowhere. Washington Post.

Retrieved from https://www.washingtonpost.com/news/storyline/wp/2014/08/08/why-denver-is-trucking-its-

homeless-to-the-middle-of-nowhere/?utm_term=.5ac87b981cd4; State of Colorado. (2013, May 24). Fort Lyon provides new tool in statewide effort to end homelessness [Press release]. Retrieved from

https://www.colorado.gov/governor/news/fort-lyon-provides-new-tool-statewide-effort-end-homelessness ($43,240

in 2012 dollars). 51 Hirsch, E., PhD, & Glasserq, I., PhD. (2007). Rhode Island’s Housing First Program First Year Evaluation

(Rep.). Page 2. RI. Retrieved from:

https://www.muni.org/Departments/health/Documents/Rhode%20Island%20Housing%20First%20Evaluation.pdf

($31,617 in 2007 dollars). 52 Rhode Island Coalition for the Homeless, Homelessness Statistics. Retrieved from:

http://www.rihomeless.org/AboutHomelessness/HomelessnessStatistics/tabid/248/Default.aspx. 53 Indeed, the overall number of homeless individuals in Colorado has increased over eight percent since 2013, and

the number of homeless households has risen over 27 percent in the same time period, according to reports from the

U.S. Department of Health and Human Services.

27

54 Drugs and the Workplace (Issue brief). (n.d.). Retrieved March 29, 2017, from National Council on

Alcoholism and Drug Dependence Inc. website: https://www.ncadd.org/about-addiction/addiction-update/drugs-and-alcohol-

in-the-workplace. 54 Recent incidents in the United States and abroad underline this point. The engineer involved in a 2016 train crash

that killed two line workers in Pennsylvania tested positive for marijuana use after the wreck, per a National

Transportation Safety Board report. Halsey, A., III. (2017, January 26). Amtrak engineer in fatal crash tested positive for marijuana, NTSB says. Retrieved March 29, 2017, from

https://www.washingtonpost.com/local/trafficandcommuting/amtrak-engineer-in-fatal-crash-tested-positive-for- marijuana-

opioids-ntsb-says/2017/01/26/27e7fba6-e3f0-11e6-a453- 19ec4b3d09ba_story.html?utm_term=.ab53162c3c70.

And more recently, two employees at a German BMW plant who got high just before reporting to their stations

caused over $1 million in losses after they caused an assembly line stoppage. Brown, A. (2017, March 20). Stoned

Assembly Line Workers Cost BMW $1 Million in One Day, Report Claims. Retrieved March 29, 2017, from http://www.thedrive.com/news/8449/stoned-assembly-line-workers-cost-bmw-1-million-in-one-day-

reportclaimsutm_content=inf_10_3522_2&xid=socialedge_pd&tse_id=INF_930fda1010c911e7af245d7f4020bc76. 57

CNBC.com. (2016). America's Top States for Business 2016: The list and ranking. Retrieved from

http://www.cnbc.com/2016/07/12/americas-top-states-for-business-2016-the-list-and-ranking.html. 58 Zwerling, C., (1990). “The Efficacy of Preemployment Drug Screening for Marijuana and Cocaine in Predicting

Employment Outcome.” JAMA: The Journal of the American Medical Association. 264.20. 2639. 59 Id. 60 Substance Abuse and Mental Health Services Administration (SAMHSA). (2015) National Survey on Drug Use

and Health, 2014. Rockville, MD: Office of Applied Studies, SAMHSA. 61 Circadian. Absenteeism- The Bottom Line Killer (Rep.). Retrieved from http://www.workforceinstitute.org/wp-

content/themes/revolution/docs/Absenteeism-Bottom-Line.pdf; Investopedia. The Causes and Costs of Absenteeism in the Workplace. (2013, July 10). Forbes. Retrieved from:

https://www.forbes.com/sites/investopedia/2013/07/10/the-causes-and-costs-of-absenteeism-in-the-

workplace/#77f8b93b3eb6. 62 Rhode Island Department of Labor and Training. Rhode Island Establishment Employment - Seasonally Adjusted

Current Month Comparison. (2017). Retrieved from http://www.dlt.ri.gov/lmi/ces/cescompare.htm. 63 Substance Abuse and Mental Health Services Administration (SAMHSA). (2016) National Survey on Drug Use

and Health. Rockville, MD: Office of Applied Studies, SAMHSA. The NSDUH reports state-level data annually as

the average of the previous two-year period, and data for the 18+ age cohort from the recent past is available starting

in 2012-13. This is likely a conservative estimate—if the average annual rate of increase in Colorado is calculated

using data for the other relevant age cohort, that of people 26 years of age or older, the average annual change is

even higher in this time period. 64 Zwerling, C., (1990). “The Efficacy of Preemployment Drug Screening for Marijuana and Cocaine in Predicting

Employment Outcome.” JAMA: The Journal of the American Medical Association 264.20.2639. 65 U.S. Bureau of Labor Statistics. Fatal occupational injury rates by industry, 2015, Rhode Island. (2016, December

16). Retrieved from https://www.bls.gov/iif/oshwc/cfoi/rate2015ri.htm. 66U.S. Bureau of Labor Statistics. Occupational Injuries and Illnesses (Annual) News Release. (2016, October 27).

Retrieved from https://www.bls.gov/news.release/archives/osh_10272016.htm. 67 Table A-9. Selected employment indicators. (2017, March 10). Retrieved March 29, 2017, from U.S. Bureau of

Labor Statistics: https://www.bls.gov/news.release/empsit.t09.htm. (seasonally-adjusted data for Feb 2016) 68 National Safety Council. (2013). Injury Facts. 2013 Edition. Retrieved from:

http://www.mhi.org/downloads/industrygroups/ease/technicalpapers/2013-National-Safety-Council-Injury-Facts.pdf 69

The National Academies of Science, Engineering and Medicine. The Health Effects of Cannabis and Cannabinoids-

Chapter Highlights (Issue brief). (2017, January). Retrieved from:

28

http://nationalacademies.org/hmd/~/media/Files/Report%20Files/2017/Cannabis-Health-Effects/Cannabis-chapter-

highlights.pdf. 70 United States Public Health Service, Office of the Surgeon General (2016.). Facing addiction in America: The

Surgeon General's report on alcohol, drugs and health. Retrieved from:

https://addiction.surgeongeneral.gov/surgeon-generals-report.pdf. 71 Kimbrel et al., Cannabis use disorder and suicide attempts in Iraq/Afghanistan-era veterans. Journal of

Psychiatric Research. 89, 1-5. Retrieved from: https://www.ncbi.nlm.nih.gov/m/pubmed/28129565/. 72 The National Academies of Science, Engineering and Medicine. The Health Effects of Cannabis and

Cannabinoids-Chapter Highlights (Issue brief). (2017, January). Retrieved from:

http://nationalacademies.org/hmd/~/media/Files/Report%20Files/2017/Cannabis-Health-Effects/Cannabis-chapter-

highlights.pdf. 73 Kimbrel et al., Cannabis use disorder and suicide attempts in Iraq/Afghanistan-era veterans. Journal of

Psychiatric Research. 89, 1-5. Retrieved from: https://www.ncbi.nlm.nih.gov/m/pubmed/28129565/. 74 Wilkinson et al., (2015). Marijuana Use is Associated with Worse Outcomes in Symptom Severity and Violent Behavior in Patients with Posttraumatic Stress Disorder. Journal of Clinical Psychiatry. 76 (9), 1174-1180.

Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/26455669. 75 Max et al., (2014). The Cost of Smoking in California, 2009. San Francisco, CA: Institute for Health & Aging,

University of California, San Francisco. Retrieved from http://www.trdrp.org/files/cost-smoking-ca-final-report.pdf. 76 Nestoros, J. N., Vakonaki, E., Tzatzarakis, M. N., Alegakis, A., Skondras, M. D., & Tsatsakis, A. M. (2017,

March). Long lasting effects of chronic heavy cannabis abuse. The American Journal on Addictions. Wiley-

Blackwell. https://doi.org/10.1111/ajad.12529 77 Manrique-Garcia, E., Ponce de Leon, A., Dalman, C., Andréasson, S., & Allebeck, P. (2016, August). Cannabis,

Psychosis, and Mortality: A Cohort Study of 50,373 Swedish Men. American Journal of Psychiatry. American

Psychiatric Publishing. https://doi.org/10.1176/appi.ajp.2016.14050637 78 Id. 79 Rocky Mountain HIDTA Investigative Support Center Strategic Intelligence Unit. The Legalization of Marijuana

in Colorado: The Impact, Volume 4. Sept. 2016 (citing CO Department of Revenue). 80 Subbaraman, M. S., & Kerr, W. C. (2015, April 14). Simultaneous Versus Concurrent Use of Alcohol and

Cannabis in the National Alcohol Survey. Alcoholism: Clinical and Experimental Research. Wiley-Blackwell.

https://doi.org/10.1111/acer.12698 81 Id. 82 Tullo, Danielle. "There's A Weed-Infused Wine On The Market — But There's A Catch". Cosmopolitan. Oct. 11,

2016. Retrieved from: http://www.cosmopolitan.com/food-cocktails/a5274780/pot-wine-canna-vine/. 83 Kaplan, More. "Cannabis Cocktails? Constellation Sees Opening As Pot Laws Ease". Bloomberg.com. Nov. 10,

2016. Retrieved from: https://www.bloomberg.com/news/articles/2016-11-10/weed-liquor-corona-executive-sees-

opportunity-in-legalization. 84 Weinberger, A. H., Platt, J., & Goodwin, R. D. (2016, April). Is cannabis use associated with an increased risk of

onset and persistence of alcohol use disorders? A three-year prospective study among adults in the United States. Drug and Alcohol Dependence. Elsevier BV. https://doi.org/10.1016/j.drugalcdep.2016.01.014 85 Id. 86 The National Academies of Science, Engineering and Medicine. The Health Effects of Cannabis and

Cannabinoids-Chapter Highlights (Issue brief). (2017, January). Retrieved from: http://nationalacademies.org/hmd/~/media/Files/Report%20Files/2017/Cannabis-Health-Effects/Cannabis-chapter-

highlights.pdf. 87 See, e.g., Gorman, Anna. "Will Legal Marijuana Lead To More People Smoking Tobacco?". NPR.org. Nov. 18,

2016. Retrieved from: http://www.npr.org/sections/health-shots/2016/11/18/502567273/will-legal-marijuana-lead-

to-more-people-smoking-tobacco.

29

88 Secades-Villa R, Garcia-Rodríguez O, Jin CJ, Wang S, Blanco C. Probability and predictors of the cannabis

gateway effect: a national study. Int J Drug Policy. 2015;26(2):135-142 89 Centers for Disease Control. Today’s heroin epidemic Infographics more people at risk, multiple drugs abused.

CDC, 7 July 2015. Retrieved from: https://www.cdc.gov/vitalsigns/heroin/. 90 The National Academies of Science, Engineering and Medicine. The Health Effects of Cannabis and

Cannabinoids-Chapter Highlights (Issue brief). (2017, January). Retrieved from:

http://nationalacademies.org/hmd/~/media/Files/Report%20Files/2017/Cannabis-Health-Effects/Cannabis-chapter- highlights.pdf. 91 Zielinski, L., Bhatt, M., Sanger, N., Plater, C., Worster, A., Varenbut, M., … Samaan, Z. (2017, March 30).

Association between cannabis use and methadone maintenance treatment outcomes: an investigation into sex

differences. Biology of Sex Differences. Springer Nature. https://doi.org/10.1186/s13293-017-0130-1 92 Colorado Department of Human Services, as reported in Colorado Department of Public Safety, Division of

Criminal Justice, Office of Research and Statistics. (2016) Marijuana Legalization in Colorado: Early Findings.

Denver. 93 Colorado Bureau of Investigation & Colorado State Judicial Branch, as reported in Colorado Department of

Public Safety, Division of Criminal Justice, Office of Research and Statistics. (2016). Marijuana Legalization in

Colorado: Early Findings. Denver. 94 Sillins et al., (2014). Young adult sequelae of adolescent cannabis use: an integrative analysis. The Lancet

Psychiatry. 1(4), 286-293. Retrieved from: http://dx.doi.org/10.1016/S2215-0366(14)70307-4. 95 Belfield, C.R., Levin, H.M., & Rosen, R., The Economic Value of Opportunity Youth (2012). (prepared for the

White House Council on Community Solutions), retrieved from

http://www.civicenterprises.net/MediaLibrary/Docs/econ_value_opportunity_youth.pdf (finding a lifetime taxpayer

burden of $235,680 and a lifetime social burden of $704,020, calculated as the present value of those lifetime costs

in 2011 dollars). 96 Wang, X., Derakhshandeh, R., Liu, J., Narayan, S., Nabavizadeh, P., Le, S., … Springer, M. L. (2016). One

Minute of Marijuana Secondhand Smoke Exposure Substantially Impairs Vascular Endothelial Function. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 5(8), e003858.

http://doi.org/10.1161/JAHA.116.003858 (“One minute of exposure to marijuana [second-hand smoke, or] SHS

substantially impairs endothelial function in rats for at least 90 minutes, considerably longer than comparable

impairment by tobacco SHS. “). 97 The Centers for Disease Control and Prevention. Economic Trends in Tobacco. (2017, March 03). Retrieved from

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/economics/econ_facts/. 98 A Baseline Evaluation of Cannabis Enforcement Priorities in Oregon (Rep.). (2017). OR: Oregon State Police-

Drug Enforcement Section. Retrieved from

http://media.oregonlive.com/marijuana/other/2017/03/20/statepolicesmaller.pdf. 99 “Special report, ‘Clearing the haze:’ Black market is thriving in Colorado.” Colorado Springs Gazette, 20 Mar. 2015. Retrieved from: http://gazette.com/special-report-clearing-the-haze-black-market-is-thriving-in-

colorado/article/1548305. 100 See, e.g., Mamdooh, Sally. “Mexican drug cartels are taking full advantage of Colorado’s marijuana laws.”

7NEWS, 8 Apr. 2016. Retrieved from: http://www.thedenverchannel.com/news/local-news/marijuana/mexican-drug-

cartels-are-taking-full-advantage-of-colorados-marijuana-laws. 101 Colorado Department of Public Safety, Division of Criminal Justice, Office of Research and Statistics. Marijuana Legalization in Colorado: Early Findings. Denver, Mar. 2016. (Perversely, the increase in arrests were localized to

Latino and African-American youth, whose arrest numbers rose 29 percent and 58 percent, respectively. Arrests of

white kids for marijuana fell eight percent in the same timeframe.) 102 Rocky Mountain HIDTA Investigative Support Center Strategic Intelligence Unit. The Legalization of Marijuana

in Colorado: The Impact, Volume 4. Sept. 2016. 103 Silbaugh, L. (2016). Distribution of Marijuana Tax Revenue (04th ed., Vol. 16, Issue brief). CO: Colorado

Legislative Council. https://www.colorado.gov/pacific/sites/default/files/16-

04%20Distribution%20of%20Marijuana%20Tax%20Revenue%20Updated_2.pdf.

30